External beam radiotherapy
On this page we talk about how external beam radiotherapy can be used to try to remove localised prostate cancer (cancer that hasn’t spread outside the prostate) or locally advanced prostate cancer (cancer that has spread to the area just outside the prostate).
Radiotherapy can also be given to some men whose cancer has spread to other parts of the body (advanced prostate cancer). It may be used to help control the cancer or, more commonly, to relieve symptoms.
How does radiotherapy work?
Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy uses high-energy X-ray beams that are targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body (advanced prostate cancer). Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.
Radiotherapy usually treats the whole prostate. It's sometimes used to treat your seminal vesicles − two glands that sit behind the prostate and bladder which produce some of the fluid in semen. Radiotherapy aims to treat all the cancer cells, including any that have spread to the area just outside the prostate. The treatment itself is painless but it can cause side effects.
You may also have radiotherapy to a wider area, including the nearby lymph nodes and bones, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. But if you do have radiotherapy to a larger area, you will be more likely to get side effects.
Talk to your doctor, nurse or therapeautic radiographer if you have any questions about your treatment and possible side effects.
Who can have radiotherapy?
External beam radiotherapy can be suitable for you if:
your cancer hasn’t spread outside the prostate (localised prostate cancer)
your cancer hasn't spread to the area just outside the prostate (locally advanced prostate cancer)
your cancer has come back after treatment that aimed to cure it (recurrent prostate cancer).
If your prostate cancer is localised or locally advanced, or if you have recurrent prostate cancer, radiotherapy will aim to get rid of the cancer completely.
Your doctor will look at your general health. For example, if you already have severe urinary problems or some other health conditions, radiotherapy may make these worse. External beam radiotherapy may not be suitable if you have some types of inflammatory bowel disease (IBD), as it could make your bowel problems worse. Talk to your doctor or nurse to discuss if radiotherapy is suitable for you.
Radiotherapy for localised and locally advanced prostate cancer
If you’re having radiotherapy for localised or locally advanced prostate cancer you might also have hormone therapy for some time before, during or after treatment. Hormone therapy can shrink the prostate and the cancer inside it, and make the treatment more effective. Your doctor will let you know if you need hormone therapy and for how long you should have it. If there is a risk of the cancer spreading outside your prostate, you may continue to have hormone therapy for up to three years after radiotherapy. Read more about hormone therapy.
If there’s a risk that your cancer could spread outside the prostate, you might also be offered another type of radiotherapy called brachytherapy alongside your external beam radiotherapy. But this isn’t very common. Brachytherapy gives a high dose of radiation directly into your prostate through the perineum, which is the area between your testicles and back passage. Brachytherapy can be given either before or after treatment with external beam radiotherapy.
Having both types of radiotherapy together means you will have external beam radiotherapy to the prostate and the area just outside it, as well as an extra dose of radiotherapy directly to the prostate. This can help make treatment more effective, but might also mean you’re more likely to get side effects. Find out more about permanent seed brachytherapy and high dose-rate brachytherapy.
Adjuvant radiotherapy
Some men may be offered radiotherapy to the prostate bed (the area where your prostate used to be) very soon after having surgery to remove the prostate (radical prostatectomy). This is called adjuvant radiotherapy. It's usually given if there’s a chance cancer cells were left behind during surgery or may come back, often within the first few months of surgery. But your doctor may suggest waiting until any urinary problems after surgery have improved.
Salvage radiotherapy
Salvage radiotherapy may be offered if your PSA (prostate specific antigen) level in your blood doesn’t drop after surgery and continues to rise, or other tests show that your cancer has come back.
It's usually given a few months after surgery, once you have recovered enough for radiotherapy treatment. Your doctor may also suggest further scans to help decide if salvage radiotherapy is the best option. It's often considered when the PSA increases to around 0.2 ng/ml, although this can vary between hospitals.
You might also have salvage radiotherapy if your cancer comes back after high-intensity focused ultrasound (HIFU) or cryotherapy. Find out more on treating cancer that has come back.
Other treatment options
Other treatment options for men with localised and locally advanced prostate cancer include:
brachytherapy (either permanent seed or high dose-rate)
high-intensity focused ultrasound (HIFU) or cryotherapy, but these are less common and only available in specialist centres or as part of a clinical trial.
Radiotherapy after other treatments for prostate cancer
Radiotherapy can be an option if your cancer has come back after surgery (called salvage or second-line radiotherapy). It may also be possible after HIFU or cryotherapy. Read about treatment options if your cancer comes back.
If you have advanced prostate cancer
If your cancer has spread to other parts of the body (advanced or metastatic prostate cancer), external beam radiotherapy won’t be able to cure your cancer. But you may be offered radiotherapy to areas where the cancer has spread, to help with symptoms such as bone pain. And new research has found that giving radiotherapy to the prostate itself can help some men who’ve just been diagnosed with advanced prostate cancer to live longer. Read more about radiotherapy for advanced prostate cancer.
If you have any questions, ask your doctor, nurse or therapeutic radiographer. They can talk you through your test results and your treatment options. Make sure you have all the information you need. You can also speak to our Specialist Nurses.
What types of radiotherapy are there?
There are different types of external beam radiotherapy used to treat prostate cancer. Ask your doctor, nurse or therapeutic radiographer which type of radiotherapy you are being offered, and for how long.
Intensity-modulated radiotherapy (IMRT)
This is the most common type of external beam radiotherapy in the UK. A computer uses scans from your radiotherapy planning session to map your prostate and the organs near it to work out the precise radiation dose and create your treatment plan.
The radiotherapy machine (called a linear accelerator or Linac) gives out beams of radiation that match the shape of the area to be treated as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects. It also allows the treatment area to get the right doses of radiotherapy to get rid of the cancer. Most radiotherapy centres use a type of IMRT technique called VMAT (Volumetric Arc Therapy). It's also sometimes called RapidArc®.
Stereotactic radiotherapy
Stereotactic radiotherapy, also known as stereotactic ablative radiotherapy (SABR or SBRT), is another type of external beam radiotherapy that is available in some hospitals. SABR delivers a higher dose of radiation at each treatment session and is given in fewer sessions overall. The course of treatment is therefore shorter than standard external beam radiotherapy. It's a very precise treatment that can be delivered on a standard Linac machine.
Stereotactic radiotherapy can also be delivered on different machines. Cyberknife® is one type of a specially designed machine that can deliver SABR. Your therapeutic radiographer can tell you which machine they will use for your treatment. SABR is newer than some other types of radiotherapy. Studies show it works as well as standard external beam radiotherapy, but we still need long-term results. In the UK, it's usually only available in certain specialist centres, on as part of a clinical trial. Speak to your doctor, nurse, or therapeutic radiographer for more information.
Proton beam therapy
You might have heard of a type of radiotherapy called proton beam therapy. It uses beams of tiny particles called protons to target and kill cancer cells. In the UK, it’s mainly used to treat children and adults with very rare and complex types of cancers. Proton beam therapy isn’t used to treat prostate cancer because standard radiotherapy such as IMRT works just as well or better.
A clinical trial is a type of medical research that aims to find new and improved ways of preventing, diagnosing, treating and managing illnesses. There are clinical trials looking into the best ways of using radiotherapy to treat prostate cancer.
Read more about clinical trials. Or to find out about taking part in a clinical trial, ask your doctor or nurse, or speak to our Specialist Nurses.
What are the advantages and disadvantages of external beam radiotherapy?
Everyone's experience of prostate cancer is different and what may be important for one person may be less important for someone else. If you’re offered external beam radiotherapy, speak to your doctor, nurse or therapeutic radiographer before deciding whether to have it. They can tell you about any other treatment options and help you decide if radiotherapy is right for you.
Advantages of external beam radiotherapy
If your cancer is localised or locally advanced, radiotherapy will aim to get rid of the cancer completely.
Many men can carry on with many of their normal activities while having treatment, including going to work and driving.
Radiotherapy can be an option even if you’re not fit or well enough for surgery.
Radiotherapy is painless (but you might find the treatment position slightly uncomfortable).
The treatment itself only lasts around 10 minutes, including the time needed to get you into position. But you’ll probably need to be at the hospital for up to couple of hours each day to prepare for your treatment. You don’t need to stay in hospital overnight.
Disadvantages of external beam radiotherapy
You may need to go to a specialist hospital for treatment five days a week for a few weeks. This might be difficult if you need to travel far.
Your bladder may need to be full, and your bowel may need to be empty during each treatment session. You may be given medicine to help empty your bowel each day and it could take a while to work. Some men may find this process difficult and inconvenient.
Radiotherapy can cause side effects such as bowel, urinary and erection problems, as well as tiredness and fatigue. But there are usually treatments and ways to help manage these.
There is a small increase in the risk of getting other cancers after radiotherapy. It is not very common.
It may be some time before you know whether the treatment has worked.
If you have radiotherapy as your first treatment and your cancer comes back or spreads, it might not be possible to have surgery afterwards. This is because the radiotherapy may have damaged the prostate and surrounding tissues, making it harder to remove the prostate and increasing the risk of side effects.
Each treatment session may take longer than usual if you’re very overweight. This is because it can take more time to get you into the right position for treatment.
Some studies suggest that side effects of radiotherapy can also be worse for men who are very overweight. Read more about having a healthy lifestyle.
What does external beam radiotherapy involve?
External beam radiotherapy treatment includes:
a planning scan
bladder and bowel preparations
treatment sessions
follow up appointments.
What are the side effects of radiotherapy?
Like all treatments, external beam radiotherapy can cause side effects. These affect each man differently, and you might not get all the possible side effects.
Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy.
Read more about the side effects of external beam radiotherapy
Questions to ask your doctor, nurse or radiographer
You may find it helpful to keep a note of any questions you have to take to your next appointment.
What type of radiotherapy will I have?
How many sessions will I need?
What other treatment options do I have?
What are the possible side effects and how long will they last?
What treatments are available to manage the possible side effects from radiotherapy?
Will I have hormone therapy and will this carry on after radiotherapy?
What will my follow-up appointments after radiotherapy look like (will they be face-to-face or by telephone) and how often?
When will a PSA blood test be done after treatment?
How and when will I know if radiotherapy has worked?
If the radiotherapy doesn’t work, which other treatments can I have?
Who should I contact if I have any questions?
What support is there to help manage long-term side effects?
List of references and reviewers
Updated: March 2026 | Due for Review: March 2029
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Marguerite Bingle, Prostate Cancer Clinical Nurse Specialist, East Suffolk & North Essex NHS Foundation Trust
Deirdre Dobson, Deputy Head of Radiotherapy, Guy’s Cancer at Queen Mary’s Hospital
Oliver Hulson, Consultant Radiologist, St James University Hospital, Leeds
Joe O’Sullivan, Consultant Oncologist, The Northern Ireland Cancer Centre, Belfast
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